Provider Demographics
NPI:1851414635
Name:LUMMI INDIAN BUSINESS COUNCIL
Entity Type:Organization
Organization Name:LUMMI INDIAN BUSINESS COUNCIL
Other - Org Name:LUMMI TRIBAL HEALTH CENTER- PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C&R SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOLSOM
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:360-312-2489
Mailing Address - Street 1:2592 KWINA RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9278
Mailing Address - Country:US
Mailing Address - Phone:360-384-0464
Mailing Address - Fax:
Practice Address - Street 1:2592 KWINA RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9278
Practice Address - Country:US
Practice Address - Phone:360-384-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7132152Medicaid